Without proper planning, it is not a question of if, but rather when, you will become constipated when your pain management regimen includes opioid or narcotic pain medication. If you are taking these medications regularly or considering incorporating them as part of a treatment plan, consider discussing a constipation prevention or bowel regimen with your doctor. In addition to constipation, pain medications can lead to other side effects related to your gastrointestinal (GI) system such as bloating, feelings of being full after eating only small amounts of food, and even more pain, sometimes referred to as “narcotic bowel syndrome.” Why Do Painkillers Lead To Constipation? Pain medications bind to specific receptors in the bowels that slow transit through the body. As a result, more water is removed from stool and stool becomes dehydrated, leading to bulkier, harder stools that move more slowly through the bowels. If this is combined with any of the risk factors below, the constipation effects add up. Risk Factors Not everyone’s risk for narcotic-induced constipation is the same. A number of risk factor increase your risk, such as: Increasing age Decreased activity or immobility: the more active you are, the less likely you will experience constipation Poor diet Use of other constipating drugs (e.g. amitriptyline, iron tablets) Elevated levels of calcium in your blood Adhesions (scars inside of your abdomen) from a prior abdominal surgery or some similar process in your abdomen that could mechanically interfere with your GI tract Neuropathy or abnormalities of nerves that push food through your GI tract; this problem occurs in certain diseases like diabetes What Can I Do? There are a number of things you and your doctor can do to decrease your risk or problem with constipation, but make sure you discuss changes with your doctor before taking action. Non-constipating options include: 1. Decreasing your dose. Most side effects from pain medications are dose dependent. As you increase your dose, the risk of side effects increases. Decreasing dose often decreases side effects. 2. Changing medication. There are a number of different types of medication or therapies that may help with chronic pain. Choosing a non-constipating one may help you decrease the dose of your constipating medication, or you may not need it at all. Capsaicin, acetaminophen, ibuprofen and anticonvulsants are options that are less constipating than narcotic painkillers. 3. Consider non-pharmacological procedures. Certain procedures may also help decrease the need for constipating pain medications. Spinal chord stimulation and transcutaneous electrical or nerve stimulation (TENS) are procedures that can help with pain management. Biofeedback, hypnosis, and relation therapy can be used alone or in combination with monitoring devices to make patients more aware and teach them specific maneuvers that may decrease pain. 4. Increasing fluids. Because painkillers draw water out of stool, you may need to compensate with increased fluid intake to make sure your stool remains soft. 5. Increasing fiber. There are a number of ways you can increase fiber in your diet. Eating peas, beans, fresh fruits, vegetables, oats, and whole grains are excellent ways to increase fiber. Consider starting your day with a cereal that has 3 grams of fiber per serving or a high fiber ready-made shake. Granola bars and trail mix are options when you are on the run. 6. Scheduled laxative. If dietary modification and lifestyle modifications are not effective, you and your physician may need to consider a preventive (prophylactic) or scheduled laxative to keep you going. This often will consist of both a stool softener and a cathartic—a medicine that will help you go. One over-the-counter regimen that may help is taking 100 mg of docusate twice daily and two senna tablets at bedtime. 7. Prescription medication. If you and your doctor decide a prescription would work better for you, daily lactulose or polyethylene glycol are options. There are also newer prescription medications such as naloxegol (Movantik) or methylnaltrexone bromide (Relistor) that prevent opioids from binding to receptors in the bowel and cause constipation. Painkiller-induced constipation can be frustrating, but there are a number of possibilities for prevention and treatment. Work with your doctor to develop a regimen to prevent constipation symptoms when you start on a pain medication or if you need to treat symptoms after beginning treatment.